Covid Vaccination for 16-64 year olds at increased risk (Group 6)

Briefing information about vaccination programme that started for our patients in January 2021

We will be inviting you book an appointment for your first COVID vaccination fairly soon.

This letter is to give you more information about this so that when we ring you all your questions have been answered and the call will be to give you a time and date for the vaccination.  We hope to be able to book appointments soon for your group, however, this will be dependent on the vaccine delivery date and these are not confirmed until a few days before they arrive.

Why am I in group 6? (all individuals aged 16 to 64 years with underlying health conditions which put them at higher risk of serious disease or mortality (and those in receipt of a carers’ allowance or are the main carer of an elderly or disabled person whose welfare may be at risk if the carer falls ill).

The Joint Committee on Vaccinations and Immunisations (JCVI) advises the government on the priority groups for the order of vaccination based on the severity of the illness should the person catch Covid-19.  This is largely dependent on age but also on underlying health conditions and their treatments.  Those at the highest risk from these are shielded patients and have already been vaccinated in group 4 of the clinically extremely vulnerable individuals.

The JCVI advice on group 6 is to offer vaccination to those aged 64 to 16 with:

  • Chronic respiratory disease including COPD, cystic fibrosis and severe asthma (needing regular daily preventative inhalers, not intermittent use)
  • Chronic heart and vascular disease (this includes atrial fibrillation, ischaemic heart disease and peripheral vascular disease but not high blood pressure without any complications)
  • Chronic kidney disease
  • Chronic liver disease
  • Chronic neurological disease including epilepsy
  • Severe and profound learning disability (on our learning disability register, Down’s syndrome is in group 4)
  • Diabetes
  • Solid organ, bone marrow and stem cell transplants
  • Some cancers (especially those of the blood system)
  • Immunosuppression due to disease or treatment (many will have been in group 4)
  • Asplenia and splenic dysfunction (including coeliac disease)
  • Morbid obesity (BMI >40)
  • Severe mental illness

The main differences with those who should have a ‘flu vaccination is that pregnancy is a contraindication to Covid-19 vaccination (at present) and some people with milder chest conditions may have an annual ‘flu vaccination but do not fall into the Covid-19 vaccination group 6.

The practice clinical system has nationally written searches based on the JCVI guidance that generate the list of people t invite in each group based on their medical records.  GPs have to follow these guidelines and can only add someone to a group if their medical condition changes (e.g. a new illness or treatment that increases the risk) or they become a main carer or stat a job as a front-line health or social care worker.

If you are in this group and aged 16 or 17 you should have the Pfizer vaccination.

These vaccinations will take place at the Michael Herbert Hall in Wilton (NOT at the surgery) at a clinic run by our (the Sarum West) Primary Care Network (PCN).

If there are other members of your household in a higher risk group you may have received a letter similar to this one in the past few weeks.  Please read on as the information is constantly updated.

We cannot invite other household members who are in lower risk groups (aged under 65 but not at increased risk).

The first vaccinations for older people have gone well.  We get about a week’s notice of the vaccine delivery and Hindon Surgery will be allocated one or two clinics with up to 40 appointments each booking every three minutes.  As soon as the appointments are available to book we will call everyone in your risk group starting with those people in your group in descending age order of the oldest household member as the oldest are at the most risk.  Sometimes extra appointments become available at shorter notice and we will work on through our booking list should this happen.  The clinics can be on any day of the week and between 0800 to 2000 (so far usually from 0900 and in daylight hours as the extra capacity has not been needed as the vaccine had all been used.)

If we cannot contact you on your landline or mobile we may leave a message or send a text or email asking you to call back.  Please do this as soon as possible (see the surgery opening hours on our website of when your call will be answered) as we will continue to book appointments until there are none left or we have run out of patients to contact.  If you delay you may find all the appointments have gone and you have to wait another week or longer.

It is possible you will have received a nationally generated letter inviting you for vaccination elsewhere in a national mass vaccination site.   A site opened at the end of January at the City Hall in Salisbury if you do get an invitation and want to go there please follow the instructions sent with that invitation and if we contact you and you have already booked or been vaccinated you just need to update us.  If you are already booked for the Wilton clinic please do not change to the one in Salisbury as your Wilton vaccine may be wasted if we cannot book another person to that appointment.   All the vaccinations are recorded on a national database with the information transferred to your notes but information about appointments elsewhere is not recorded and the lists we work off to ring you will have been produced some time before the call.

You must have your second vaccination from the same organisation as your first and they are responsible for contacting you to arrange this (presently three months after the first vaccine).  You cannot switch  between providers – that means if you are vaccinated by our PCN clinic in Wilton we will contact you for your second vaccination and it will be at a PCN site.  If you accept a national invitation to go to Salisbury City Hall they will invite you for your second vaccination there.  The same applies to our patients vaccinated through their work (e.g. in a hospital arranged clinic) or sites elsewhere.

At present Salisbury Hospital is not vaccinating any patients being seen or looked after in the hospital (despite national media saying this would be happening).  This is because they have only been supplied with the Pfizer vaccine and it is logistically impossible to take this to patients on the wards or clinics and it is only given at a special clinic to their front-line staff.  It is also impossible to arrange a second dose by them.

Location (PLEASE READ THIS SO YOU GO TO THE RIGHT PLACE – it is NOT the surgery)

Vaccinations will take place at The Michael Herbert Hall on South Street, Wilton, SP2 0JS. There is good parking next to the hall in a public car park and there are gentle ramps up to the front door.

Some clinics may be during very cold and icy weather.  Please come prepared and take care.  The most problems at pilot sites were people falling over rushing to get their vaccination.

There are restricted toilet facilities at the Hall. A short sleeve blouse or shirt under your coat will make the clinic run smoothly.

Pilot sites report the process worked best when people turned up at the time of their appointment (and not early, it is impossible to vaccinate earlier than the time you will be given and this caused significant traffic problems).  If you do arrive early please stay in your car until a minute or two before your appointment time.

Having someone else to drive you to and from the clinic works well for anyone with reduced mobility.  Your driver will need to wait in the car but can help you to the door of the Michael Herbert Hall if you need assistance.

Volunteers from Wilton Rotary Club will direct you to a parking space and show you where to go.  They have donation tubs near the entrance to enable you to show your appreciation for their work for the months of the programme that help make it run so smoothly.

If there is a queue please respect the concerns of other people waiting by properly socially distancing and not chatting excessively to others in the queue.  For many people this is one of the very few times they will have left their home since March 2020 and may be anxious about mixing with so many other people.  Please behave as though everyone coming for vaccination could have asymptomatic Covid-19 infection and use all the well-established methods to reduce risk to you and from you (keeping 2m apart, wear a mask, avoid touching as far as possible, avoid producing droplets and don’t touch your face).  All the staff at the clinic have had their first vaccination and are tested regularly but they will be following all these guidelines.

The whole appointment should take about half an hour (and many patients report it takes less than this and people have not been waiting outside in long queues):

  • There are plenty of people helping guide you outside and inside the hall
  • Please put on a face covering before driving into the car park (as you may be giving instructions on where to park) and keep on when entering the hall.
  • Maintain social distancing at all times.
  • In the front lobby there will be one or two reception desks and a desk with information leaflets should you want one (please take one as it is something to read when waiting before or after your vaccination).
  • You will be called forward to book in and asked your name, have your temperature taken and you may be given a card with a record of the vaccination. Please keep this.  Apply hand sanitiser; there are bottles on the reception desks and move forward towards the door of the main hall.
  • This area is run by final year pupils from Salisbury Grammar Schools thinking of a career in medicine.
  • You may be asked to sit down to wait to be called forward for your vaccination. This is a good time to take off coats & jerseys so that the arm you want to be vaccinated is ready (the vaccination is into the deltoid muscle at the top of the upper arm just below the shoulder joint).
  • Please stay where you have been asked to sit and not wander around the hall – this is to maintain infection control measures.
  • You will be called forward to sit at the vaccination station where the vaccinator will ask you a number of questions that include:
    • Confirming that you are not unwell with an infectious illness
    • Confirming you have been given information about the vaccine
    • Asking if you have any questions about the vaccine
    • Asking your consent to vaccinate
    • Checking on serious allergic reactions (ones needing emergency medical help or an adrenaline injection – we shouldn’t have invited you if this was on your records but this is a final check)
    • Checking if you are on blood thinning medication (warfarin, apixaban, edoxaban, dabigatran, rivaroxaban, aspirin or clopidogrel) These do not prevent you being vaccinated but you may have a small bruise afterwards
    • Checking if you have had any other vaccination in the previous seven days (e.g. ‘flu, shingles, Pneumovac)
  • If all is OK and we hope your answers can be brief as anything lengthier should have been answered in this briefing or by the surgery before you go for your vaccination. If you feel you need to discuss things at greater length please do so before the clinic or postpone your jab.
  • There are hardly any medical conditions or treatments that mean you cannot be vaccinated but if you have any concerns please discuss these with the surgery before attending the clinic. They will not have your notes and they will not have the time to check anything except those mentioned above and that you do not have an acute illness that day that should delay vaccination.
  • If you have had a proven Covid-19 infection you should be vaccinated but not for 28 days after the positive test or the first symptoms. GPs are not told about positive tests (the results are filed automatically in your notes but there is no message to alert the GP that this has happened).  Please tell us when you are called if you have not already done so.
  • You will not be offered a choice of who will vaccinate you. All are health care professionals trained to give this vaccine safely and in accordance with the licencing regulations and may well have introduced themselves at the start of their questions.
  • You may feel a sharp sting when vaccinated but many people feel nothing at all. If you want to be certain you have been vaccinated you can look at your arm during the procedure but most people prefer to look away or answer any questions from the person entering your vaccination onto the computer record.
  • Once vaccinated you will be shown to another chair in an observation area in the hall where you will have to wait for 15 minutes (please bring something to keep yourself occupied). Again please don’t wander around.
  • You will be given a slip of paper with the time of the vaccination and 15 minutes later. There is a clock in the hall and when you get to the second time you can leave by the door at the far right of the hall.  There may be hand sanitiser to use there or use some when you get back to your car and when home follow your usual routine of hand washing.

Hidden disabilities

The PCN has signed up to the “Hidden Disabilities Sunflower Scheme” to better recognise and help anyone who may have special needs addressed during the vaccination process.  You can identify yourself by buying and wearing a Sunflower lanyard (they cost 55p) and details and very good information about the whole Covid vaccination programme is available on https://hiddendisabilitiesstore.com/our-nhs-your-sunflower

This has links to buy the lanyard and other useful badges.

If you are unwell on the day of the appointment (fever, symptoms of an infection, especially a new cough, sore throat or loss of smell or taste please do not come to the vaccination location but contact NHS111 in case you need a test for Covid-19 infection and Hindon surgery to put you on the list to invite for vaccination for another date).

Please read the information below carefully, so that you are able to verbally consent to the vaccination on the day.   More information is available on the government website:
https://www.nhs.uk/conditions/coronavirus-covid-19/coronavirus-vaccination/coronavirus-vaccine/

Who can get the COVID-19 vaccine?
You can only get the vaccine from the NHS (it is FREE and any requests from any organisation offering vaccination for a payment and requesting bank details should not be followed and you should report this to the police) and at the time of writing over twelve million people have been vaccinated starting with those most at risk:

  • most people aged 80 and over
  • people who live or work in care homes
  • front-line health and social care workers

In Wiltshire some areas have been pilot sites that started in late December 2020 to vaccinate people aged 80 and over and some health and social care workers.  These clinics went well and with more vaccine available the programme was rolled out to local PCN sites across Wiltshire including ours in Wilton.  You may know people who were vaccinated some weeks ago and others not yet started.  It depends on the vaccine availability and approval of their vaccination sites and recruitment of staff and this varies across the country.  At present each PCN can only vaccinate from a single site except for patients who are in care homes (and the care home staff) and the genuinely housebound (those who never leave their homes).  Our PCN has vaccinated all of these patients except those unwell on the day of the vaccination visit.

The first vaccinations were offered to people aged 80 and over and front-line health staff (group 2) followed by those aged 70 and over (groups 3 and 4) and we are booking patients aged 65 and over (group 5).  We have now vaccinated all housebound patients.  If you have become housebound since we did this on 12 and 19 January 2021 please let us know.  However, we are not due to be supplied with any more vaccine for housebound patients until this group are due their second dose in mid-April.  Access to the Hall is possible by wheelchair and help is available.  We have vaccinated or booked vaccination appointments for most patients aged 65 and over and are now able to offer appointments to the next tier of patients who are aged 64 to 16 at increased risk (group 6) and that includes you.

Because of the limited quantities of vaccinations available at the start of the programme we will be inviting those at most risk in each of the age cohorts.  Risk increases with age and some long term conditions.  For group 6 we will invite you in descending age order staring with those aged 64.  If you are younger you will be invited a little later than someone older in your group but the delay will be a week or two at most.   We will also invite households where one member could have been invited sooner but preferred to wait to be vaccinated at the same appointment as another member of the household.  Similarly if there are two or more members of the same household in the same risk group we will invite you all to the same clinic triaged to the person at the highest risk.

How the COVID-19 vaccine is given
The COVID-19 vaccine is given as an injection into your upper arm. 
It is given as 2 doses, at least 21 days apart for the Pfizer vaccine or 28 days for the AstraZeneca vaccine.

In late December 2020 the national guidance changed to having the second dose up to twelve weeks after the first so that as many people as possible have a first dose.  This will give a good level of protection but it is still important to come for your second dose when invited as this will further boost your immunity and make it last longer.

How safe is the COVID-19 vaccine?
The COVID-19 vaccines approved for use in the UK were developed by Pfizer/BioNTech and AstraZeneca.  They have met strict standards of safety, quality and effectiveness set out by the independent Medicines and Healthcare products Regulatory Agency (MHRA).  Any coronavirus vaccine that is approved must go through all the clinical trials and safety checks all other licensed medicines go through. The MHRA follows international standards of safety.

Other vaccines are being developed. They will only be available on the NHS once they have been thoroughly tested to make sure they are safe and effective.

The Pfizer/BioNTech vaccine was the first to be delivered locally and was also the first to be used in the PCN clinic in Wilton.  It is very fragile and is not suitable in situations needing several journeys as well as having difficult storage requirements.  Once delivered to the Wilton clinic it cannot leave that site and has to be used within three days of delivery.

The Oxford AstraZeneca vaccine became available locally from mid-January for residents of care homes and their staff and the housebound.  It was also available at the Wilton clinics from mid-January and is the only vaccine suitable for those with past serious allergic reactions needing adrenaline.

So far, over twelve million people in England have been given a COVID-19 vaccine and reports of serious side effects, such as allergic reactions, have been very rare. No long-term complications have been reported.  We have given the Oxford AstraZeneca to a number of patents with past serious allergic reactions to other things and there have been no adverse reactions.

How effective is the COVID-19 vaccine?

After having one dose of the COVID-19 vaccine most people will be protected against coronavirus.  It takes a few weeks after getting the first dose for it to work.  The second dose improves the effectiveness and needs to longer lasting immunity. The second dose must be with the same vaccine as the first.  There is a small chance you might still get coronavirus even if you have the vaccine.  This means it is important to:

  • continue to follow social distancing guidance
  • if you can, wear something that covers your nose and mouth in places where it’s hard to stay away from other people
  • You should continue to follow national guidance on keeping safe and any restrictions on movement.
  • You will not be given a letter or certificate that says you don’t have to follow the rules that continue to apply to all of us but you may be given a card with the date and details of the vaccine given.

The second dose of vaccine will be approximately twelve weeks after the first and we will contact you closer to the appointment date.  We cannot book this second appointment now as we do not know what vaccine supplies will be available then or the organisation of the clinic.  Please put a note in your diary / on your calendar to expect a call from us twelve weeks after your first vaccination date. This dose must be given by the same organisation that gave you the first one.

It is very important that younger family members and friends do not think they can ignore national guidelines on visiting and social distancing / infection control measures and put pressure on you to come and visit after you have been vaccinated or that you relax your own personal infection control measures.  The immunity takes several weeks to build up and you can still catch Covid-19 despite this and may be infectious should this happen.  Vaccination is vital but it will only work when combined with all the other measures.

COVID-19 vaccine side effects

Most side effects of the COVID-19 vaccine are mild and should not last longer than a week, such as:

  • a sore arm where the needle went in
  • feeling tired
  • a headache
  • feeling achy

You can take painkillers, such as paracetamol, if you need to.  If you have a high temperature you may have coronavirus or another infection.

If your symptoms get worse or you are worried, call 111.

The vaccination does not protect you for all the other things that can cause illness and apart from those mentioned above is very unlikley to cause any serious symptoms.  If you get these in the days after vaccination please act as you would normally and get medical advice.  You may well have a completely different illness unrelated to having been vaccinated.  It is also possible that you had caught Covid-19 before the vaccination and had no symptoms when vaccinated but developed then afterwards. That is why it is important to contact 111 if you develop a fever, new cough and loss of taste or smell in the days after vaccination as you may need testing.

Allergic reactions

Tell staff before you are vaccinated if you have ever had a serious allergic reaction (anaphylaxis).

You should not have the Pfizer vaccine if you’ve ever had a serious allergic reaction to medicines, vaccines, food, or to a bee or wasp sting. This may mean you carry an adrenaline pen.

The Oxford AstraZeneca vaccine can be given in these circumstances with the provision that you are observed for about 15 minutes afterwards.

If you do have a reaction to the vaccine, it usually happens in minutes.  There are also non-allergic reactions to any vaccination (like feeling faint). This is why you will need to wait at the vaccination clinic for 15 minutes after your vaccination and should not drive for 15 minutes afterwards.  Staff giving the vaccine are trained to deal with allergic reactions and treat them immediately.

Advice about the period of observation for each vaccine is reviewed frequently but the advice to not drive for 15 minutes after any of the vaccinations is unlikely to change even if the need to spend this time under clinical observation may change as more experience of real-life use increases.

This is a hugely positive step forwards after such a difficult year for everyone and we would ask you to seriously consider having a vaccination.  So far almost all our patients have accepted the invitation to be vaccinated.  This vaccination not only protects you but reduces the risk of you being admitted to hospital and taking up a bed that cannot be used for all the other care only hospitals can provide and that has been postponed because of the Covid-19 pandemic (like cancer and other major  life saving or life enhancing surgery). Vaccination is part of every individual’s efforts to control this virus and get back to normal sooner with less loss of life.

Our experience from the first invitations was that we had very little time to book people into the clinics and to avoid delay we rang everyone who needed to be vaccinated.  This worked very well as almost everyone had read the information and were able to accept the date and time offered.

Some patients have some form of call-blocking in place and because many of the surgery ‘phone lines do not allow ‘call-back’ we found some patients did not answer our calls which caused problems.  If you get an unexpected call in the next couple of weeks please answer it as it may be the surgery trying to book the appointment.

At pilot sites there were reports of long discussions about the vaccine and the clinics.  With only two lines for the surgery (01747 820222) and limits on the number of staff who can take calls due to social distancing rules, we will not have time for this which is why you are being sent this detailed information. This is also why many of the calls are made outside surgery hours in the evenings and at weekends.  Our experience has been that everyone booked very efficiently and if they had queries sent an email to us on hindon.surgery@nhs.net.

If you do not want to be vaccinated please just let us know (an email is fine).  Please remember the vaccination is both to protect you but also protect the NHS by reducing your chance of catching Covid-19 and being admitted to hospital.  By mid-January around 130 of the 400+ beds at Salisbury Hospital were occupied by patients with Covid-19 and some, very sadly, had died from this disease. This coincided with high levels of staff sickness with the ability f the hospital to function under serious threat.  Not only are they seriously unwell but these beds are unavailable for other patients with all the other usual planned and emergency needs to be in hospital.  Elsewhere hospitals have had to cancel all planned care and are struggling to do emergency operations and tests for patients with cancer.  Having this vaccination helps lots of other people as well as protecting you.

If you feel you should have been invited or know someone who feels they should have been invited but haven’t been – please contact the surgery or ask them to contact the surgery.

Dr Patrick Craig-McFeely and Dr Sally Hayes

Partners, Hindon Surgery

08 February 2021